I think it must be confusing for anyone new to the world of counseling and therapy and psychotherapy to make sense of these three terms. In Portland, Oregon where I practice, or anywhere in the U.S., the questions are basically the same. What is counseling? What is therapy or psychotherapy? Are they different? To understand these terms is not quite so hard as it seems.

When you decide to “get into therapy” or “find a counselor,” typically you’re looking for someone to talk with, often for an hour a week, on a regular basis and for a period of time ranging from a few months to a few years. This can vary, but I’m giving you an idea of what’s typical. So, if you’re looking to work with a therapist or counselor for awhile, what do you need to know about the various terms you will encounter?

There are at least two ways to look at the terms: one is based in common sense, and a basic understanding of language; the other is based in the way various state and other official groups regulate the profession of psychotherapy, and in how these groups decide to use and regulate the various terms.

I’ll focus on the common sense version. This is according to me and is not an official view, though I think it’s pretty accurate.

Counseling and Counselor are common terms. To me they convey a more practical approach–helping to guide a client into strengths and away from negative ways of living. Some counselors seem to emphasize guidance and advice. But that’s not always the case, and often counseling is the same essential process as therapy or psychotherapy.

Therapy and Therapist are common terms as well. Sometimes they’re applied to fields like physical therapy which have nothing to do with psychological and emotional health. But in the context of working with psychological issues, they are general terms that refer to any practitioner who works therapeutically with individuals, couples, families, or groups.

Psychotherapy and Psychotherapist just make things more specific. When you’re working with a human being on psychological issues, you’re working with the “psyche” of that person. Psyche comes from an ancient Greek word meaning soul–the living reality of a human being. Psychotherapy is a therapy for the living human being. The word therapy itself comes from a Greek word meaning to care for, attend to, or heal some condition that ails the patient.

The terms your own therapist likes to use will depend largely on personal preference.

The state and the associations that regulate the various licenses that therapists hold have their own preferred ways of using the terms counselor, or therapist, or psychotherapist. I won’t get into these details here, and I can’t speak for any official groups. The important thing to know is that if you’re seeking counseling… or therapy… or psychotherapy (use the term that you prefer!) for something that ails you, just make sure you do a little research and inquire about your potential therapist’s background and qualifications. See if that person feels like a good fit for you, and then begin and see where the process of therapy takes you.

Now that I’ve entitled this blog entry, “How to Choose a Therapist,” I should tell you that no one, including me, can really tell you the right way to choose a therapist. Just like therapeutic work itself, choosing a therapist is both an art and a science. You will need to use your intuition–calling on your deepest instincts as best you are able. You will also need to use some basic knowledge–keeping in mind the essentials to good therapy.

The bottom line is that you should respect your intuition about who is a good fit for you. But it’s also important to know the basics about what to look for, what to expect, what to want, and what not to want.

On the intuitive side of the decision, consider these thoughts:

Different therapists have different styles of working with clients. There is no one right style, but there may be ways of doing therapy that work especially well for you. It’s important to find someone who is a good enough match for you, your temperament, and your particular needs. The therapist should feel to you like an intuitive “good enough fit,” after you’ve had at least one introductory session, and perhaps a few sessions. A good fit does not necessarily mean easy and fun all the time, especially since therapy by its nature ends up dealing with a client’s difficulties. Working through difficulties can be challenging–another reason to find the right therapist.

Coming to therapy involves focusing a special kind of attention on your life and your self. Most people report not having many places (if any) where this kind of attention feels possible. The attention involves a certain kind of care towards, and tending of psychological processes. Some therapists will feel to you like a more natural fit for the job of attending you through these processes. And whatever the initial problem or symptom you brought to therapy, the more complex reality that you’re bringing to therapy is you and your way of being in the world. Things are rarely cut and dry, because we are all quite complex human beings with lots going on at any one time. That’s why therapy (in my view) is as much or more an art than it is a science.

Now for the basic knowledge side of the decision.

First, look for someone with at least these qualifications: a legitimate graduate degree in the field of psychology, counseling, social work, psychiatry, etc. You should also look for someone who is active in the field, who seeks consultation with senior colleagues, who follows the basic ethics of being a therapist, and who has undergone a significant therapy process as a client, as part of training to do this work. This last qualification has a strong basis in the history of modern psychotherapy. Personal therapy has been an important part of training therapists for over a century. Your therapist should also have a personal philosophy and approach to doing therapy and be able to talk to you about it in ways that make sense to you.

In terms of how your therapist should relate to you and the work you are doing together, it is important for a therapist to maintain a real, respectful, and authentic human connection with you, at the same time as maintaining a professional boundary, competence in the field, and commitment to keeping open, curious, careful attention on you, your emotional life, your relationships, dreams, struggles, symptoms, and development as an individual.

When you get to the point of wanting to make some calls, you can explore your options in various ways. You can ask for names of therapists from friends (though you may not want to share a therapist with your best friend or partner), or doctors, or other healing professionals. You can browse the web and read what various therapists have to say on their websites. Sometimes a client finds the right fit quickly. Other times it is good to meet two or more therapists for an initial consultation and then choose one to return to and see for a few sessions. Some therapists charge for a first consultation and some do not. You can ask, and you can also ask what the fee would be for ongoing sessions. Some take insurance, and some do not. Some will reduce the fee if there is a real financial need for a lower fee, and some will not.

These thoughts are not meant to be a complete guide to choosing a therapist, but I hope that they give some readers a good start.